Healthcare Provider Details

I. General information

NPI: 1487724738
Provider Name (Legal Business Name): DARREL STEVEN SWYTER CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 OREGON ST
KELLOGG ID
83837-2016
US

IV. Provider business mailing address

7905 N MEADOWLARK WAY STE. C
COEUR D ALENE ID
83815-5041
US

V. Phone/Fax

Practice location:
  • Phone: 208-783-0427
  • Fax:
Mailing address:
  • Phone: 208-762-3979
  • Fax: 208-762-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00001406
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: